Alzheimer's disease is now the sixth-leading cause of death in the United States, with more than 5 million Americans now living with the disease. With the increasing rate of costs associated with Alzheimer's disease, research is directed at early identification strategies that are of value economically, medically and socially.

The Affordable Care Act has a new benefit for Medicare beneficiaries — a free annual wellness visit. As part of this visit, physicians are required to determine the patient's cognitive function.

The Alzheimer's Association supports the use of cognitive screening for dementia and has developed a recommended assessment strategy involving patients and caregivers — utilizing tools for cognitive or health risk assessment, patient observation and unstructured questioning. A guide for screening is available from the Alzheimer's Association.

But recently reported findings by the United States Preventive Services Task Force (USPSTF) raise questions about the benefit of universal screenings for dementia.

The USPSTF reviewed findings applicable to the universal screening using formal cognitive screening instruments in community-dwelling adults over the age of 65 with no signs or symptoms of cognitive impairment. They concluded that there was insufficient evidence to determine a benefit of screening for cognitive impairment.

This finding adds to concerns about the burden that the required screening places on primary care physicians. The worry is that there is not adequate time during the exam to obtain an extensive history as well as administer a formal cognitive screen. The result is that the cognitive screen may not get done, and it simply adds one more item to an extensive to-do list.

"There doesn't seem to be, on a group basis, a clear way to decide whether there is sufficient benefit to justify screening," expressed Dr. Eric Tangalos, an internist and professor of medicine at the Mayo Clinic in Rochester, Minn. "But patients may think differently for themselves, and individual physicians may think differently."

The USPSTF group did report that there are useful tools for screening for cognitive impairment:

Given that the presumptive diagnosis of Alzheimer's disease can be alarming and to date there are no truly effective treatments, many patients would forgo a screening and choose to not know.

However, there are numerous reasons for a patient and his/her family to know about cognitive issues. Among the reasons are:

  • Some dementias are reversible
  • It may prove to be a relief
  • The screening results may contribute to decisions such as cessation of driving and legal planning
  • An understanding of dementia symptoms may improve family relationships
  • There are medications that may help with symptoms of dementia

An additional reason provided by John Riley McCarten, M.D., in his presentation to the American Geriatrics Society in 2013 is that "screening promotes awareness."

There is no doubt that Alzheimer's disease is having an impact socially and financially. Regarding this public health concern, McCarten commented that there is a need to "identify the scope and impact of common, disabling and costly disease."